Speaking Spanish Limits Access to Health Care

WEDNESDAY Sept. 17, 2008 -- Spanish-speaking Hispanics in the United States have difficulty accessing the health-care system, University of North Carolina researchers report.

"We found that the U.S. Spanish-speaking adult population represents a particularly vulnerable subset of U.S. Hispanics, with far worse access to the health-care system," said lead researcher C. Annette DuBard, from the Cecil G. Sheps Center for Health Services Research.

One out of five U.S. residents speak a primary language other than English at home, and almost one in 10 report an ability to speak English less than "very well," according to U.S. Census figures from 2006.

Until recently, methods for monitoring the health status of the population and progress toward public health objectives have often been limited to the English-speaking population, DuBard noted. "Fully addressing health-care disparities will require a better understanding of contributing factors within the rich diversity of the U.S. population," she said.

The report was published in the Sept. 17 online edition of the American Journal of Public Health.

For the study, DuBard and her colleague, Ziya Gizlice, from the university's Center for Health Promotion and Disease Prevention, collected data on 45,076 Hispanic adults across the United States. This represents about 90 percent of the U.S. Hispanic population. The data came from the 2003 to 2005 Behavioral Risk Factor Surveillance System.

DuBard and Gizlice found that Spanish-speaking Hispanics had significantly lower rates of chronic disease, obesity and smoking. They engaged in less physical activity, and they lagged behind in the use of preventive health-care services.

In addition, more than half of Spanish-speaking adults lacked health insurance and a personal physician, and one out of four were unable to seek needed care in the past year because of cost, DuBard said. "Language-associated disparities in access to care are most pronounced in regions of the country experiencing rapid new growth of the Hispanic population," she added.

Priorities for addressing the health needs of the Spanish-speaking population include promotion of physical activity and healthy weight, and improved access to affordable, timely, language-appropriate care, DuBard said.

William Vega, a professor of family medicine at the David Geffen School of Medicine at the University of California, Los Angeles, thinks that poverty, not language, is the real culprit in the lack of access to health care among Hispanic Americans.

"It is a bit unfortunate that the authors of this piece choose to create the impression that language was a causal factor in receiving less care or lower quality of care," Vega said. "Spanish language use is a proxy of low acculturation, lower income, and lower education in the Latino population, and studies have shown that this language differential does not persist across generations, that is, the children of immigrants quickly become English-language dominant in childhood even when Spanish is their first language," he said.

Spanish language dominance is a transitional status routinely found in immigrant groups, especially recent arrivals, and not a permanent impediment that is passed forward to new generations, Vega said. "Regrettably, a disproportionate percentage of Latino immigrant families are also in poverty, which is the real impediment to receipt of medical care of adequate quality," he said.

The authors of the study are correct that self-reported health status is not accurate for Latino immigrants, Vega said. "In fact, it is contradicted by self-reported lower ratings of health problems and chronic medical conditions in major health surveys going back 20 years," he noted.

Rea Panares, director of Minority Health Initiatives at Families USA, said the main problem of access to health care among Spanish-speaking Americans is lack of health insurance, not language.

"One of the barriers to access is language, and we have seen that in a number of different reports and studies in the past," Panares said. "Spanish-speaking patients are less likely to have access to health care, mainly due to cultural and language barriers."

More than 70 percent of Spanish-speaking Hispanics are uninsured, particularly in new growth areas, Panares said. "That's a stark finding," she said. Part of the problem is that the federal government does not reimburse states for health-care costs for new legal immigrants.

Panares noted that there is a federal five-year ban on eligibility for public benefits for all legal, documented immigrant children and pregnant women. While some states offer benefits, others do not, she said. "This points to why we need national health-care reform," Panares said.

Another study in the same journal found that along the U.S.-Mexican border, the number of uninsured increased 7 percent from 2000 to 2005.

"Results from this study indicate that existing disparities in health-care access will continue to undermine the health status of the region's population unless major health-care policy reforms are initiated to promote greater accessibility to U.S. health care," the University of Texas researchers concluded.

In a third study, researchers from the Children's Hospital of Philadelphia found poor U.S.-born children were as likely as foreign-born children to have public insurance coverage. But after 2000, foreign-born children were 1.59 times more likely to be uninsured compared with U.S.-born children.

"In the various discussions of proposals for universal child health coverage, policies designed to promote the healthy growth of this highly under-served population merit serious consideration, given their potential to ensure the future socioeconomic well-being of an increasingly diverse American population," the authors wrote.